HAMDEN PUBLIC SCHOOLS FIELD TRIP PERMISSION FORM Class of 2021 Six Flags Field Trip SCHOOL: HAMDEN HIGH SCHOOL DESTINATION: Six Flags New England, Agawan, MA TRIP DATE: Monday, June 14, 2021 ADVISORS: Mrs. Gaffney/Dr. James DEPARTURE TIME: 9:30 A.M. RETURN TIME: 5:30 P.M. COST: $50.00 for admission and transportation. Transportation only, $20.00 (for pass holders) I hereby give my son/daughter/student ________________________________________ permission to participate in the field trip activities indicated above, during the dates as noted. I understand that this activity involves travel to and from the destination indicated above. I also understand that this activity DOES NOT involve staying overnight. I understand and acknowledge that the Hamden Board of Education (“Board”) is the legal entity that operates Hamden Public Schools (“HHS” or “District”). CONDUCT DURING ACTIVITY: I understand that my child’s participation in the activity is a privilege, and not a right. I acknowledge that I have spoken with my child about my child’s need to comply with the specific rules and requirements established for this activity; all District policies and procedures; rules of conduct set forth in the Student Code of Conduct; and, state and federal regulations and laws. I understand that all District rules and policies apply to my child and the other students during the course of the field trip. INFORMATION FOR EMERGENCY USE: Does your child have any recent health issues, including allergies that the school nurse is not aware of, or that the chaperone should be aware of? [ ] Yes [ ] No If yes, please explain: Does your child take medication in school? [ ] Yes [ ] No Name of mediation: Time taken: Should an emergency arise, I hereby give the staff in charge permission to arrange for immediate treatment. Parents/Guardians will be notified immediately. EMERGENCY CONTACT INFORMATION: Parent/Guardian Name: Home Address: email address: Telephone: cell, work, or home Emergency Contact Name and phone number: Student Name and Grade PARENTAL CONSENT AND RELEASE FORM FOR FIELD TRIPS Hamden Public Schools CONSENT FOR: ● Acknowledgement of Personal Liability ● My Child to Ride with Private Drivers ● My Child to Drive to Activity TRANSPORTATION PERMISSIONS AND WAIVER: I also understand that private drivers, which may include my child (pending my written permission below), a teacher, an administrator, or the parent of another student participating in the activity, may be used to transport students to and from the activity. The owner of the vehicle must carry bodily injury insurance. The District’s insurance does not cover damages arising from, or related to, the operation of any private vehicle, failure to follow the directed driving route, or any personal negligence related to this activity. Any damages/harm resulting from a parent/guardian/or other designated driver (including student-drivers), arising from the operation of a motor vehicle in relation to the above listed activity, is hereby waived. ❏ Six Flags Admission Ticket and Transportation: $50.00 ❏ Six Flags Admission Ticket Only: $30.00 ❏ Transportation Only: $20.00 ACKNOWLEDGEMENT OF PERSONAL LIABILITY AND WAIVER: I also understand that this field trip may expose my child to some risks and I assume any such risk that may arise there from. I accept full responsibility for all medical expenses for any injuries that might occur to my child by reason of his/her participation. By signing this form, however, I hereby release HHS, its Board, its Board members, administrators, directors, officers, teachers, employees, agents, assigns, and volunteers (“released parties”) from and against any and all claims, demands, actions, complaints, suits or other forms of liability that any of them may sustain (a) arising out of my child’s failure to comply with local, state, and federal laws and District policies, procedures, and the Code of Conduct; (b) arising out of any damage or injury caused by my child; or, (c) arising out of a parent/guardian/or other designated driver’s operation of a motor vehicle in relation to this activity. I also agree to indemnify and hold harmless the released parties from the released claims, including any and all related costs, attorney fees, liabilities, settlements, and/or judgments. SIGNATURE: I confirm that I have carefully read this CONSENT AND RELEASE and and is understood by me and I agree to its terms knowingly and voluntarily. I also confirm that I am the parent or legal guardian of the child or I am a student 18 years or older. _____________________________________________ _________________ Student's signature (If 18 years or older) Date _____________________________________________ _________________ Signature of Student's Parent or Legal Guardian Date (if student is less than 18 years)
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